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China Now Has More Than 880 000 Rural Doctors, About 110 000

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China Now Has More Than 880 000 Rural Doctors, About 110 000 News should be provided by health work- China’s village doctors take great strides ers and epidemic prevention staff in villages. In 1957, there were already Village doctors have dramatically improved access to health care in China’s rural more than 200 000 village doctors communities over the last few decades. Cui Weiyuan reports. across the nation, enabling farmers to receive basic health care at home and China’s barefoot doctors were a major and a system has been developed that work every day. The barefoot doctor inspiration to the primary health care provides some health service for the scheme was simply the reform of medi- movement leading up to the confer- great majority of the people.” cal education in the 1960s. In areas ence in Alma-Ata, in the former Soviet Dr Zhang Zhaoyang, the deputy lacking medicine or doctors, village Republic of Kazakhstan in 1978. These director general of China’s Depart- doctors could go through short-term health workers lived in the community ment of Rural Health Management, training – three months, six months, a they served, focused on prevention says the barefoot doctor scheme had year – before returning to their villages rather than cures while combining west- a profound influence on the Declara- to farm and practise medicine.” ern and traditional medicines to educate tion of Alma-Ata. “WHO research in people and provide basic treatment. the 1970s found problems relating to Dr Philip Lee, then a professor the health-cost burden and unequal of social medicine at the University of distribution of health resources. To try China now has California in San Francisco, wrote glow- to solve the inequality, it did research more than 880 000 ingly in the Western Journal of Medicine in nine countries, including four rural doctors, about about China’s primary health care sys- cooperation centres in China. China’s tem after visiting the country in 1973 experience inspired WHO to launch 110 000 licensed as part of a United States of America the health for all by 2000 programme.” assistant doctors (USA) medical delegation. He said Zhang says the barefoot doctor and 50 000 health prior to the founding of the People’s scheme, initiated by central govern- workers. Republic of China in 1949, epidemics, ment but largely administered locally, Dr Zhang Zhaoyang infectious disease and poor sanitation had its origins in the 1950s. “The were widespread. “The picture today is name barefoot doctor became popular dramatically different … there has been in late 1960s after an editorial in the Zhang says the scheme has evolved a pronounced decline in the death rate, People’s Daily by Chairman Mao in over the decades, though the term particularly infant mortality. Major 1968,” he says. “The name ‘barefoot barefoot doctor is no longer used. “The epidemic diseases have been controlled doctor’ originated in Shanghai because scheme has never stopped. In the early … nutritional status has been improved farmers in the south were often 1980s, the State Council (the Central [and] massive campaigns of health barefoot working in the paddy field. People’s Government, the highest education and environmental sanitation But China’s village doctors had been executive organ in China) directed have been carried out. Large numbers there long before. In 1951, the central that barefoot doctors, after passing an of health workers have been trained, government declared basic health care examination, could qualify as a ‘village doctor’. Those who failed would be health workers and practise under the guidance of the village doctors. The village doctors and rural health work- ers still undertake the most primary health work – prevention, education, maternal and child health care, collect- ing disease information. The quality of [care provided by] rural doctors keeps increasing in line with social and economic development.” Dr Liu Xingzhu, the programme director at the Fogarty International Centre at the National Institutes of Health in the USA, was a barefoot doctor from 1975–1977. Aged 19, his senior secondary school classes were interrupted during the Cultural Revolution drive to equip people with practical skills. “The county’s health bureau organized medical training in WHO/M Grata my school and provided free accom- Three barefoot doctors, part of a production brigade near Shanghai. modation and food. The trainers were 914 Bulletin of the World Health Organization | December 2008, 86 (12) News the best from the county’s central Liu Xingzhu believes health-care per 100 000 before 1949 to today’s 41.3 hospital in various fields. Many of the services did suffer in the late 1970s and per 100 000. The infant mortality rate doctors were dispatched from the ur- early 1980s when the agricultural sector for the same period has decreased from ban hospitals during the Down to the was privatized. “The barefoot doc- 200 per 1000 to 18.6. China now has Countryside Movement (when Mao tors, who were paid collectively by the more than 880 000 rural doctors, about decreed ‘privileged’ urban youth go to commune, lost their source of income. 110 000 licensed assistant doctors and rural areas to learn from workers and Many turned to farming or industry. 50 000 health workers.” He believes farmers) and showed great profession- The most direct effect was that few primary health care has also helped alism. They were very good trainers did inoculations or provided primary reduce poverty in China. “Only with and doctors. health care for the peasants. Many dis- a health body can people undertake “After graduating in June 1975, eases that had been eradicated emerged education and production activities and I became a barefoot doctor at the in the countryside again.” improve their living standards. Village Suliuzhuang commune (in north- doctors have played a significant role western Shandong Province, south in preventing people from becoming of Beijing) serving 1800 residents. impoverished.” Despite the knowledge I learned from I was lucky Despite the challenges China faces the strict training, the conditions and because I had in providing a modern health-care ser- equipment in the countryside were passed a Ministry vice to all of its 1.3 billion people, the very limited. I was given only a bag of of Health exam in barefoot doctors and their successors some basic medicine with two syringes 1981 and acquired can still show the way to the rest of the and 10 needles.” world in primary health care, accord- Therein lay both the strength the certificate to ing to Zhang Lingling. Writing in the and weakness of the barefoot doctor practise as a village Young Voices in Research for Health scheme. It provided the rural poor doctor. 2007 essay competition sponsored by with health care not known in pre- Dr Liu Yuzhong the Global Forum for Health Research Revolution days, but the doctors’ lim- and the Lancet, the doctoral student at ited training, equipment and medical the Harvard School of Public Health supplies meant they could not do a lot. The user-pays system introduced said: “The impact of barefoot doctors Another of the barefoot brigade, in China in the 1980s left many out of in rural health-care services still exists. Dr Liu Yuzhong, still offers basic pocket or unable to afford treatment. Today, both researchers and policy- health care to his fellow villagers after The government in recent years has makers have widely acknowledged it is 43 years’ service. Now 69, he is known recognized the need to increase health hard to bring people to work in rural by patients as a caring, skilful doctor, spending and promote new health areas. Even the developed countries though he says, “I learned something insurance schemes, a reflection perhaps have experienced a difficult time at- of everything, but specialized in of China’s special commitment to a tracting medical professionals to rural nothing.” He adds: “There are great primary health care system that “every- places [so] training local people seems advantages to having a barefoot doctor one can enjoy, reflects social equality, to be the optimal solution [in] build- in the village. The patients are all my is affordable for everyone and matches ing sustainability in rural health-care neighbours. I know each family’s situ- social and economic development,” ac- services.” ation, lifestyle and habits. Since I see cording to Zhang. Dr Lei Haicho of the Liu Xingzhu also believes the my patients very often, even if I cannot Department of Health Policy and Regu- Chinese model can inform other coun- diagnose precisely the first time, I can lation at the Ministry of Health, says tries’ approach to primary health care. follow up closely and give a better the New Rural Cooperative Medical “Chinese experience showed that to diagnosis the next time.” Scheme introduced in 2003 now covers promote primary health care, the key When the rural cooperative health- more than 800 million rural residents, issues are human resources and medi- care system was dismantled in the while public financing of the health cine. Chairman Mao advocated there 1980s as a result of China’s economic system has increased substantially. was no need for five years’ training; liberalization, Liu Yuzhong was hired Zhang maintains, however, health- one year was enough to train a doc- by the local Dingfuzhuang Health Cen- care standards have risen steadily in tor. Short-term training focusing on tre on the eastern outskirts of Beijing. China, thanks in part to the work of specific types of work, such as antiviral “I was lucky because I had passed a village doctors and health workers, who, treatment or prenatal care, is sufficient Ministry of Health exam in 1981 and he says, receive excellent training and to meet the demands of primary health acquired the certificate to practise as a support.
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